Provider Demographics
NPI:1780083667
Name:MOLINARO, MICHAEL J (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MOLINARO
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 TWIN HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1027
Mailing Address - Country:US
Mailing Address - Phone:630-373-5550
Mailing Address - Fax:
Practice Address - Street 1:277 PENINSULA FARM RD STE J
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1018
Practice Address - Country:US
Practice Address - Phone:410-975-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07662235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist